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Incorporating performance improvement methods into a needs assessment: experience with a nutrition and exercise
Shelly-Ann Fluker1, Ursula Whalen, Jason Schneider
1Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA. shelly-ann.fluker@emory.edu
Journal of General Internal Medicine
|August 26, 2010
Summary
Performance improvement (PI) methods revealed a significant gap between internal medicine residents' self-reported and actual nutrition and exercise counseling rates for hypertensive patients. PI techniques offer a valuable framework for medical education curriculum development and outcome measurement.
Area of Science:
- Medical Education
- Performance Improvement
- Cardiovascular Disease Prevention
Background:
- Physician counseling on diet and exercise is recommended but often suboptimal.
- Internal medicine (IM) residents require enhanced training in nutrition and exercise counseling for hypertensive patients.
Purpose of the Study:
- To assess the feasibility of using performance improvement (PI) methodologies in a needs assessment for an IM residency curriculum.
- To enhance understanding of curricular needs for nutrition and exercise counseling.
Main Methods:
- 158 IM residents completed a Knowledge, Attitudes, and Practices (KAP) questionnaire.
- Chart abstraction was used to determine baseline counseling rates.
- Fishbone diagrams identified perceived barriers to counseling.
Main Results:
- Residents self-reported high counseling rates (90%), contrasting with low chart-documented rates (3-4%).
- KAP assessment revealed knowledge deficits and low self-efficacy.
- Fishbone analysis identified patient apathy, comorbidities, and time constraints as key barriers.
Conclusions:
- Incorporating PI methods into curriculum needs assessment is feasible and provides unique insights.
- PI techniques can serve as an educational strategy and outcome measurement tool.
- PI principles offer a robust framework for developing and evaluating medical education curricula.
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